Understanding the cancer that killed CBC great Arthur Black

All of us at the CBC mourn the loss of our dear colleague and Canadian icon Arthur Black. It's a great loss, and his passing is also a painful reminder that pancreatic cancer is one of the most aggressive forms of the disease and among the most difficult to treat.

Only about seven per cent of patients diagnosed with pancreatic cancer live beyond five years. In about half the cases, by the time it is diagnosed, the disease has already spread and few treatment options are available. That's why so many victims survive only months after learning they have the disease.

The pancreas is a vital part of our digestive system and produces enzymes which help break down food. It also produces insulin to regulate blood sugar levels. When cancer appears and the tumour is small, the pancreas can maintain normal function. This is often called the "silent period" because all too often there are no symptoms. If patients are lucky enough to have their cancer detected at this stage, the tumour can be removed surgically and the chances of survival increase significantly. But even then, the disease can recur.

Very often, though, people don't know they have the disease until symptoms appear and the cancer has become aggressive. The symptoms are not obviously associated with cancer and when they start to appear can be mistaken for other issues. There might be unexplained weight loss, or abdominal pains and digestive problems. Unfortunately, by the time the symptoms are recognized, the disease has often already metastasized or spread to other parts of the body and can't be treated with surgery. That is why the disease seems to take lives so rapidly. Patients don't see it coming.

Unfortunately, treatment for the cancer at this point is not usually very successful.  

Chemotherapy for pancreatic cancer can usually only slow down the progression and comes with unpleasant side effects. Sometimes patients are treated with chemo, radiation and more aggressive surgery in the later stages, but that treatment is mostly palliative — to slow the disease or relieve symptoms. At its advanced stages, there is currently no effective way to halt pancreatic cancer from its deadly outcome. Drugs to treat symptoms and make the patient more comfortable are the last option.

Advances in understanding pancreatic cancer have been slow but steady. For example scientists in Germany recently found a clue as to why pancreatic cancer spreads so efficiently and lethally. They reported that a transcription factor — a regulator protein — called Zeb 1, might be helping the cancer spread.  Zeb 1 normally helps cells migrate and survive in new environments during early embryonic development. Normally, once cells reach maturity, this factor is blocked. In pancreatic tumours, however, it appears to be reactivated, and helps tumour cells migrate and adapt to new environments in the body, such the liver or lungs, where they act as seeds for new tumours. One day, perhaps, new therapies may be developed to deactivate this factor and delay metastasis.

In the meantime, while science struggles to find ways to fight this swift killer, if you know someone who has been diagnosed with pancreatic cancer, do everything you can to find time to spend with them. And if you are unfortunate enough to have the disease yourself, focus everything on family and friends. Death always comes too soon. And the biggest regret for survivors is the things you wish you had said or done while the person was alive.

Go hug them now.

I've had the pleasure of knowing Arthur Black since the early '90s when our offices were on the same floor of the CBC Radio building in Toronto. Always cheerful, with an indefatigable sense of humour, his quirky program, Basic Black, was one of radio's most popular shows during its 19 years on air. He moved from Toronto to Saltspring Island on the West Coast because he wanted to live in a beautiful place. So when I moved west six years ago, we ran into each other frequently. I saw him last in December, when we shared a stage in Victoria along with our other CBC colleagues for our annual reading of Charles Dickens' A Christmas Carol. He looked fine then, albeit a little quieter than usual, which for Arthur was still at a higher energy level than most. None of us knew at the time that the disease had already made deadly progress. He only announced it publicly in January.

Life is indeed too short.

Farewell Arthur, you touched the country and the country will miss you dearly.